Provider Demographics
NPI:1104636596
Name:MARCUS-ATKINSON, ALEXIS
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:MARCUS-ATKINSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-866-4818
Practice Address - Street 1:10250 NORMANDY BLVD UNIT 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8064
Practice Address - Country:US
Practice Address - Phone:904-379-7155
Practice Address - Fax:904-379-7165
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037045363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology